Episode 8 - "The Leftovers" Part 1 (Steroids and Dextrose)
The Leftovers Part 1 (Steroids and Dextrose)
Released
July 2023 - 5th Monday bonus material
Hosts
John Hill
Scott Wildenheim
Caleb Ferroni
Ray Pace
Links
Steroids reduce hospital admission
JEMS Article on steroid selection
Episode Video and Audio
July Extra Episode - "The Leftovers" PT 1 - Steroids and Dextrose
Show Notes
The leftover topics from previous episodes
Medications - there is more than just ketamine in the drug box, who would have thought?
Steroids
Often "forgotten" - low on protocol - EMS not likely to see "return on investment" - long time to onset
EMS part of the global patient care continuum - early admin decreases hospital admission
Time to drug in ED is slower (evaluation, orders, order check, preparation, administration) than out of hospital with 1:1 patient care ratio
Its worth the time, and patient care improvement to give in prehospital care
Useful in both adult and pediatric populations
Most common in our area - methylprednisolone - there are others, similar features / effects
What if we give it to the wrong patient? - Generally safe, cases may be multi etiology and may benefit even if there is a relative contraindication
Get it on board after acute treatments started (don't have to be "working") as early as possible
Magnesium
Need to know your Medical Directors views on where they want you to use, early or late - some variable thoughts on this
Generally safe, not going to get into trouble with BP with 2 grams - usually already hypertensive and tachycardic.
Dextrose Concentrations
Have both D5 and D10 in the drug box
The 5% is for mixing drugs - not useful in treating acute hypoglycemia - supplied in 100ml bags - 5 grams of dextrose - suitable for mixing all med, some dont "like" normal saline
The 10% is for treatment of hypoglycemia - supplied in 250ml bag - 25 grams - not syrup, flows easy
50% is only supplied as the backup if 10% unavailable - 25 grams - syrup, does not flow easy
Glucometers
Use capillary blood, not calibrated for venous blood
know your glucometer read range <low >hi
We treat < 70 and / or symptomatic, if they normally "live" high, "low" for the patient could be higher than normal - treat symptoms
Determine patient normal range if able
Vitals
Required. If it wasn't documented it wasn't done
Must trend, one set is a single snap shot time
Is glucose and capnography now standard?
Manual blood pressures still best practice to validate the machine - defiantly
Monitor collects and trends - use to your advantage - import to ePCR, there are no questions on what's true - delete obviously erroneous info
Worth the time to set the NIBP interval down on critical patients
Always use the event log, even if narrative is complete - nobody gets "credit" if not in event log - narrative is not reportable, event log is reportable
The Protocols
From The Episode
Scott and Caleb discuss EMS Curriculum
Caleb thinks Scott is old. He is not, but has a cheezy smile.
Dr. Hill Discusses Lantus
Ray emphasizes manual blood pressure assessment